Healthcare processes and facilities are closely inter-related in complex ways, and by reducing inefficiency in emergency department processes, a hospital can reap substantial savings in both facility and operational costs. Because these processes and interdependencies can be quite complex, a detailed analysis that includes process benchmarking, data analytics of patient-level data and computer simulation modeling is often warranted.

In process benchmarking, the challenge is to find analogies in other industries in which providers are facing similar issues. For example, a pit crew servicing a race car between laps can provide insight into the value of providing services in a parallel, as opposed to linear, fashion. In the traditional intake process, patients must explain their presenting issues repeatedly — to a greeter, the triage nurse, the nurse who actually cares for them, the technician and finally the physician. A more efficient approach could be modeled on the pit crew: providers converge on the patient at the same time, requiring the patients to tell their stories only once.

Computer Simulation

The emergency department can also use computer simulation to validate proposed modifications to processes, staffing levels and physical layout and adjacencies. This strategy can make an impact across many areas:

Staffing and resource issues. Many emergency department design solutions begin by developing a range of likely scenarios for future utilization and documenting existing processes in patient care, including each specific step involved and the length of time required. Based on the findings, a simulation model can test various staffing scenarios and solutions — well before any costly remodeling is undertaken.

Excessive walking. In some cases, clinicians and staff spend significant time walking from one part of the ED to another in order to treat a patient. To address such inefficiencies, emergency department designers can use a “time and motion” study to gather measurements of the physical distances staff members must travel in order to complete specific tasks. Then they can utilize computer simulation to test different floor plan configurations to optimize the locations of often-used support services.

Finding better locations for patients. Sometimes, repurposing a space within the ED can better meet patient needs and, at the same time, improve efficiency. For example, by creating a sub-waiting area where patients can sit and be monitored while waiting for results, an ED can accomplish two quite different goals. First, this approach can give patients a private place to wait for results, while freeing up a very expensive location within the ED that is better suited to patient treatment. Second, it can reduce the likelihood of patients walking out of the treatment area into the general waiting area and being out of the view of caregivers.

Possible solutions are everywhere

Improving emergency department efficiency is often difficult to achieve, due to the complex relationship between facilities, processes, people and patient volume. However, by taking a methodical approach and incorporating relevant data into the process, EDs can optimize the likelihood of successful change.

It’s worth exploring every viable solution — and doing so in a way that avoids committing significant capital until solutions are thoroughly tested.

Delia Caldwell is a Principal and Director of Project Delivery at FreemanWhite. She works with ED staff to put the systems and processes in place they need to improve and save lives. Through simulation modeling, process mapping and dashboard tools, she helps EDs reduce LOS, improve patient outcomes and streamline operations. Having completed more than 75 ED projects, her efforts have redefined the way that providers deliver care.

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